Alcohol history

Question 1

How would you structure an alcohol history?

Answer 1

1. Gathering information
2. Past medical history
3. Drug history
4. Family history
5. Social history
6. ICE
7. Motivational interviewing

Question 2

What domains would you explore to gather information?

Answer 2

1. Onset - when did they start drinking, do they drink every day, most days? What time do they have their first drink? Do they need a drink in the morning?
2. Character - what do they drinks? Do they drinks alone, or with friends? How much do they drink?
3. Associations - Experienced not being able to stop drinking, once they had started? Been unable to do the things expected of them, due to their drinking? What happens when they do not drink, what do they experience?
4. Asks about times / events / places that may prompt patient to drink more? Asks about times / events / places that may prompt patient to drink less?
5. Have they ever tried to quit before? How did that go? Longest period of abstinence?
6. CAGE
7. Physical complications of alcohol abuse

Question 3

What is CAGE?

Answer 3

Screening method for alcohol abuse and dependency

C - have you ever felt that you should cut down on your drinking?
A - have other people annoyed you by criticising your drinking habits?
G - Have you ever felt guilty about drinking?
E - Do you need an eye opener in the morning?

More than 2 points: alcohol dependent

Question 4

What are the physical complications of alcohol abuse?

Answer 4

1. Anaemia
2. Liver damage: cirrhosis
3. Pancreatitis
4. Reflux, PUD
5. Neurological: epilepsy, ataxia, peripheral neuropathy, amnesia
6. Psychiatric: depression (assess mood), hallucinations, Wernicke’s encephalopathy, Korsakoff syndrome
7. CVD: ischaemic heart disease, cardiomyopathy, hypertension

Question 5

What are the social complications of alcohol abuse?

Answer 5

1. Absenteeism, loss of job, divorce, driving
2. Trouble getting along with people close to you?
3. Been in trouble with the police?

Question 6

What would you ask about the social history?

Answer 6

The usual

Consider social implications of alcohol
Enquire about maintaining factors (access to alcohol, motivation to drink)

Question 7

How would you assess motivation?

Answer 7

1. Establishe patient knowledge about risks of alcohol excess
2. Explains risks of excess alcohol to patient
3. Establishes patient desire to quit drinking
4. Asks about how important this is to the patient on scale of 1-10 and why this is important
5. Ask about how confident they are and what concerns they have
6. Asks if they can think of anything that would make them feel more confident

Question 8

What would you suggest for quitting?

Answer 8

Never cold turkey, reduce gradually

Check confidence in quitting at the end of the consultation

Question 9

What is the management for alcohol abuse?

Answer 9

Benzodiazepine reducing regimes (20 mg chlordiazepoxide, decreasing over 6 days)

Refer to alcohol service